Provider Demographics
NPI:1588729008
Name:SKORETZ, ROBERT J (DMD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:J
Last Name:SKORETZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:877 E SOUTH BOULDER ROAD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027
Mailing Address - Country:US
Mailing Address - Phone:303-665-8228
Mailing Address - Fax:303-200-7375
Practice Address - Street 1:877 E. SOUTH BOULDER RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-1345
Practice Address - Country:US
Practice Address - Phone:303-665-8228
Practice Address - Fax:303-200-7375
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN202054122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO32281242Medicaid